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Psychological Complications of Prostate Cancer

Psychological Complications of Prostate Cancer

The authors challenge the notion that men with prostate cancer exhibit little psychological difficulty. In fact, we do not know much about
actual distress rates in men with prostate cancer because few studies have
directly measured distress in this population. Likewise, we do not know if the
distress experienced by prostate cancer patients is qualitatively different from
that of other cancer patients. By assuming that all men with prostate cancer
"do well," we, as clinicians and researchers, may fail to ask patients
important questions.

Screening and assessment for distress should be a standard part of all
physician and clinic visits. Of primary importance is helping patients to
understand the difference between a more normative, short-lived distress and a
more enduring, impairing psychological disorder. Often, it can be comforting to
a patient to know that what he is feeling is experienced by others in his
situation. It is also important that a patient understand that his feelings may
be exacerbated by his medical regimen (eg, the influence of steroids on sleep
problems). As the authors point out, clinicians need to recognize the interplay
between medical and psychological symptoms, especially for patients undergoing
active treatment.

The Cancer Experience

The cancer experience (diagnosis, treatment, and recovery) can be construed
as a traumatic event.[1] Most patients feel some level of distress and
experience a host of emotional reactions as they attempt to "make
sense" of the trauma. Such feelings are a normal part of the cancer
experience. It is important to inform patients about the normative and often
predictable reactions to the cancer experience, from feelings of anxiety and/or
depression at the time of diagnosis and treatment decision-making, to the
bothersome effects of curative treatment on urinary, sexual, and bowel function.
However, clinicians should remain vigilant to those whose feelings of distress
do not diminish with time and/or worsen into a psychological disorder.

Implicit in Pirl and Mello’s discussion is the notion that the
health-related quality of life and distress of prostate cancer patients differs
between those with early- and those with advanced-stage disease. Several studies
have illustrated considerable differences in the experience of these two
groups.[2] Different treatments often produce different sequelae, with
early-stage patients experiencing more disease-specific complications (ie,
urinary, sexual, and bowel problems), and advanced-stage patients experiencing
more of a broad spectrum of complications (ie, pain, fatigue, appetite/weight
problems, emotional problems). Hence, different therapeutic approaches may be
necessary for early vs advanced-stage patients.

Emotional Factors

Emotional reactions to prostate cancer have several unique features that
warrant highlighting. As this is an entirely male disease, adaptation may vary
based on differences in male communication styles, need for control, and
willingness to ask for help. Also, many men with prostate cancer are older and
present with other debilitating comorbid conditions that may complicate both
their physical and emotional presentation. Finally, for many early-stage
patients, there is no definitive "best" treatment, which adds to the
anxiety that patients often experience in those early weeks of diagnosis and
treatment decision-making. Certainly, the severity of the disease, premorbid
psychological functioning, and social support all play important roles in
psychological reactions to the cancer experience.

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